CA: A Cancer Journal for Clinicians, Vol 30, 256-259, Copyright
© 1980 by American Cancer Society
Coping Mechanisms of Cancer Patients: A Study of 33 Patients Receiving Chemotherapy
Glynis Bean 1,
Sloan Cooper 2,
Renee Alpert 1, and
David Kipnis Ph.D.3
1 Doctoral Students in Social Psychology at Temple University, Philadelphia, Pennsylvania.
2 Doctoral Student in Clinical Psychology at Temple University, Philadelphia, Pennsylvania.
3 Professor of Social Psychology at Temple University, Philadelphia, Pennsylvania.
The most striking result of the analysis of the interviews is the patients' use of coping mechanisms to deal with the stress of the disease. The interviews indicate that reactions such as repression, filtering of information, regression to a childlike state of dependency on others, transference of decision-making power to the physician or the oncologic team, and the denial of having cancer altogether, are not uncommon.
In general, the patients interviewed revealed a remarkable lack of interest in receiving additional information about their illness. Most were either satisfied with the amount of information they had already received or actively denied any curiosity. We would suggest that this absence of interest should not be viewed complacently by the medical staff. We believe that the lack of interest can be attributed to defensive psychological reactions to their illness. These psychological reactions help the patient cope with the catastrophic threat to his or her life. Some hints of the presence of these coping mechanisms were dramatically revealed among a small group of patients who were afraid that their comments would reach the staff. It appears that these patients were concerned with the possible negative reactions of the medical staff if they learned of any critical comments. Their fears of possible retribution are symptomatic of the patients' feelings of powerlessness and inability to cope on their own. Such concerns are similar to those noted by Wortman and Dunkell-Schetter and by Lazarus.
An issue that emerged from the interviews concerns the communication needs of patients. They varied in the amount and type of information that they wanted; they also differed in the amount and type of information they could accept psychologically. Thus, a problem for the medical staff that must be resolved is what and how much should be told to each patient.
The cancer patients themselves face problems concerning the lack of open communication with family and friends. Although they may need to talk about their illness, they find themselves protecting family and friends by not mentioning it. Close relations seem to have difficulty handling information about the patient's disease. Consequently, the cancer patient has few, if any, emotional outlets that, because of the nature of the illness, are so desperately needed.
Finally, we would like to emphasize that feelings and needs of cancer patients are of utmost importance in providing medical care. Whether or not the medical staff can deal therapeutically with these feelings and attitudes is as yet unclear. The defense reactions developed by patients serve the important purpose of protecting them from overwhelming fears of death. These reactions regulate the kind and amount of information about cancer that patients are likely to seek out and to receive. In turn, the lack of objective information may reduce the extent to which cancer patients can assume care for themselves. An important and unanswered question at this time is the extent to which these coping mechanisms directly affect patient health. The issues raised in this research can be solved only with the aid of cancer patients themselves, and through a concentrated effort to understand the social and psychological factors influencing their ability to cope with cancer.
